MEDICARE: JOHN G ANDERSON CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN065882	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023063161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN G ANDERSON CRNA

Provider Business Mailing Address
First Line	:	PO BOX 70128
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30007-0128
Country	:	US
Telephone Number	:	770-578-1800
Fax Number	:	770-578-6168

Provider Business Practice Location Address
First Line	:	4575 N SHALLOWFORD RD
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6445
Country	:	US
Telephone Number	:	770-454-4286
Fax Number	:	770-454-4065

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	01/07/2022

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Directions to “ JOHN G ANDERSON CRNA” Practice Location

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